“laparoscopic Colonic Resections With Intracorporeal Anastomosis and Transvaginal Specimen Extraction: a Pilot Study”

Francesco Stipa, MD PhD FACS, Valentina Giaccaglia, MD, Alessio Pigazzi, MD PhD FACS, Ettore Santini, MD, Antonio Burza, MD. Department of Surgery, Colorectal Surgical Unit, San Giovanni Hospital, Rome, Italy

Purpose. Current techniques of laparoscopic colectomy require an abdominal incision for specimen extraction, which may lessen the advantages of laparoscopic surgery. Intracorporeal anastomosis may reduce the extent of colon mobilization and abdominal incision, decreasing postoperative pain and wound related complications.

Methods. A series of 10 female and 5 male patients with colon cancer underwent laparoscopic colon resection with intracorporeal anastomosis: 5 right colectomies with latero-lateral ileo-colic anastomosis, 1 transverse resection with hand sewn end-to-end colocolic anastomosis; 6 sigmoidectomies, 5 with a side-to-end stapled and 1 with manual colorectal anastomosis; and 3 low anterior resection with side-to-end stapled colorectal anastomosis. For specimen extraction, in all 10 female patients the natural orifice (NOSE) transvaginal route was used.

Results. The patients experienced no intra and post-operative complications, with early return to bowel function (mean 2 days), short time to resumption of oral solid food intake and minimal postoperative pain and narcotic use. The hospital stay was 6 days.

Conclusions. Totally laparoscopic colonic resection combining intracorporeal anastomosis and NOSE is safe and feasible. This minimally invasive technique may provide an effective way to reduce postoperative pain and abdominal wall morbidity, with low complication rate.

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